• Asian Pacific Journal of Cancer Prevention
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• v.14 no.1
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• pp.75-80
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• 2013

Background: Breast cancer is the most common cancer diagnosed in females in Sri Lanka and early detection can lead to reduction in morbidity and mortality. Aim: To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. Methods: The study consisted of two components. A retrospective descriptive arm assessed clinical breast examination (CBE) coverage of target age group women (TGW) of 35-59 years in all the WWCs in Gampaha district over 2003-2007. A cross sectional descriptive study additionally assessed quality of breast cancer early detection services. The Lot Quality Assurance Sampling (LQAS) technique was used to decide on the lot size and threshold values, which were computed as twenty and six clinics. Checklists were employed in assessing coverage, physical facilities and clinic activities. Client satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaire. Results: CBE coverage in the Gampaha district increased only from 1.1-2.2% over 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35-90%). The items that were lacking included dust bins, notice boards, stationary, furniture and linen, and cleanliness of outside premises and toilets. With regard to clinic activities, punctuality of staff, late commencement of clinics, provision of health education, supervision, CBE and breast self-examination (BSE) were substandard in 7-20 clinics (35-100%). Client satisfaction for WWC services was 45.2% (IQR: 38.7-54.8%) and only 11% had a score of ${\geq}70%$, the cut off set for satisfaction. Conclusions: Breast cancer early detection service coverage in the Gampaha district remained low (2.2%) in 2007, 11 years after commencing WWCs. All 20 clinics were substandard for overall CBE and BSE.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7639-7644
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• 2013

Background: Breast cancer is the most common cancer diagnosed among women in Sri Lanka. Early detection can lead to reduction in morbidity and mortality. The objective here was to identify perceptions of public health midwives (PHMs) on the importance of early detection of breast cancer and deficiencies of and suggestions on improving existing breast cancer early detection services provided through Well Woman Clinics. Materials and Methods: A qualitative study using four focus group discussions (FGDs) were conducted among 38 PHMs in the Gampaha district in Sri Lanka and the meetings were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. Results: All the PHMs had a firm realization on the need of breast cancer early detection. The four FGDs among PHMs revealed non-availability of guidelines, inadequacy of training, lack of skills and material to provide health education, inability to provide privacy during clinical examination, shortage of stationery, lack of community awareness and motivation. The suggestions for the improvements of the programme identified in FGDs were capacity building of PHMs, making availability of guidelines, rescheduling clinics, improving the supervision, strengthening the monitoring, improving coordination between clinical and preventive sectors, and improving community awareness. Conclusions: Results of the FGDs can provide useful information on components to be improved in breast cancer early detection services. Study recommendations were training programmes at basic and post basic levels on a regular basis and supervision for the sustainance of the breast cancer early detection program.

• Women's Health Nursing
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• v.22 no.4
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• pp.308-321
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• 2016

Purpose:This phenomenological study was to describe and to understand nurses' experiences of caring for woman with disability during pregnancy and childbirth. Methods: Participants were 13 nurses from 3 hospitals and 2 local clinics in J city, and were selected through snow-balling method. Data were collected two face to face, semi-structured interviews. The researcher used MP3 player and smart phone for recording as well as transcription process. As for the data analysis, Colaizzi's method was applied. Results: Nurses' experiences were structured as four theme clusters: 'Communicating between/among nurses', 'Recognizing pregnancy and childbirth of woman with disability', 'Taking care of woman with disability based on their differences' and 'Reflecting on nursing care for woman with disability'. Conclusion: It seemed that nurses' recognition to woman with disability and her pregnancy and childbirth was related their nursing care for woman with disability.

• Journal of Preventive Medicine and Public Health
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• v.56 no.2
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• pp.190-195
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• 2023

Objectives: Pregnancy complications, including pre-eclampsia, gestational diabetes (GDM), and perinatal mood and anxiety disorders (PMADs), impact long-term health. We compared the frequency of screening documentation for pregnancy complications versus a general medical history at well woman visits between providers in primary care and obstetrics and gynecology. Methods: We conducted a retrospective cohort study of subjects with at least 1 prior birth who presented for a well woman visit in 2019-2020. Charts were reviewed for documentation of a general medical history (hypertension, diabetes, and mood disorders) versus screening for comparable obstetric complications (pre-eclampsia, GDM, and PMADs). The results were compared using the McNemar and chi-square tests as appropriate. Results: In total, 472 encounters were identified, and 137 met the inclusion criteria. Across specialties, clinicians were significantly more likely to document general medical conditions than pregnancy complications, including hypertensive disorders (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.18 to 5.48), diabetes (OR, 7.67; 95% CI, 3.27 to 22.0), and mood disorders (OR, 10.5; 95% CI, 3.81 to 40.3). Obstetrics and gynecology providers were more likely to document any pregnancy history (OR, 4.50; 95% CI, 1.24 to 16.27); however, they were not significantly more likely to screen for relevant obstetric complications (OR, 2.49; 95% CI, 0.90 to 6.89). Overall, the rate of pregnancy complication documentation was low in primary care and obstetrics and gynecology clinics (8.8 and 19.0%, respectively). Conclusions: Obstetrics and gynecology providers more frequently documented a pregnancy history than those in primary care; however, the rate was low across specialties, and providers reported screening for clinically relevant complications less frequently than for general medical conditions.

• The Korean Journal of Cytopathology
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• v.5 no.1
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• pp.15-22
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• 1994

Cancer of the cervix is the most common malignancy in women in developing countries and the second most common cancer in women throughout the world with approximately 500,000 new cases each year. Prevention of this large number of premature deaths among women is, therefore, a goal worthy of urgent and serious consideration. Due to its high diagnostic disagreement among pathologists and large quantity of specimens, it is necessary to develop an automatic screening system measuring morphologic and densitometric features of the samples. Many research works have been published but most of them used Feulgen stained specimens which are not a usual staining method used in clinics. In this thesis, an automatic cancerous nucleus detection method essential to a screening system with papanicolaou stained specimens called Pap-smear is proposed which employs image processing techniques. It uses edge information to segment objects and morphologic as well as densitometric information to distinguish cancerous nuclei from dirts or normal nuclei. It has produced useful results in our study.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.6
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• pp.2547-2553
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• 2015

Purpose: The present study concerns the effectiveness of an educational intervention for improving knowledge, attitudes and practices (KAP) of breast cancer early detection among target group women (TGW) in the district of Gampaha, Sri Lanka. Materials and Methods: The study was a community-based intervention. Two medical officer of health areas in Gampaha district were selected using random sampling as intervention (IA) and control (CA). Public health midwives (PHMs) in the IA were exposed to the educational intervention first, conducted the same among the TGW through PHMs. KAP was assessed using an interviewer- administrated questionnaire among 260 TGW from each area selected using cluster sampling before and six months after the intervention. Results: The overall median scores for KAP among TGW in IG increased significantly from pre intervention level of 54% (IQR: 46-59%), 50% (IQR: 41-59%), and 0% (IQR: 0-20%) to post intervention level of 77% (IQR: 72-82%), 68% (IQR: 59- 76 %) and 40% (IQR: 20-60%) respectively. In CG, overall median scores for KAP remained almost the same at pre intervention 54% (IQR:44-59%), 50% (IQR:36-59%) and 0% (IQR: 0-20%) and post intervention 54% (IQR:46-59%), 50% (IQR:36-64%) and 0% (IQR: 0-20%) respectively. Conclusions: The educational intervention was found to be effective.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.1
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• pp.227-232
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• 2015

Background: Breast cancer is the commonest cancer among Sri Lankan females, accounting for 26% of the cancer incidence in women. Early detection of breast cancer is conducted by public health midwives (PHMs) in the Well Woman Clinics. The aim of the present study was to determine the effectiveness of an educational intervention on improving knowledge, attitudes and practices (KAP) on breast cancer screening among PHMs in the district of Gampaha. Materials and Methods: Two Medical Officer of Health (MOH) areas in Gampaha district were selected using random sampling as intervention (IG) and control (CG) groups. All the PHMs in the two MOH areas participated in the study, with totals of 38 in IG and 47 in CG. They were exposed to an educational intervention with the objective of using them to subsequently conduct the same among 35-59 year women in the community. Following the intervention, post-intervention assessments were conducted at one month and six months to assess the effectiveness of the intervention. Results: The overall median scores for KAP among PHMs respectively were as follows. Pre-intervention: IG:58%(IQR: 53-69%), 90%(IQR: 70-100%) and 62%(IQR: 57-70%). CG: 64%(IQR: 56-69%), 90%(IQR: 70-90%) and 62%( IQR: 50-77%). Post-intervention: one month, IG:96%(IQR: 93-96%), 100%(IQR: 100-100%), and 85%(IQR: 81-89%). CG:67%(IQR: 60- 73%), 90%(IQR: 80-100%) and 65%(IQR: 50-73%). Post-intervention: six months, IG: 93% (IQR: 91-93%), 100%(IQR: 90-100%), and 81%(IQR: 77-89%). CG: 67%(IQR: 58- 71%), 90%(IQR: 90-100%), and 62%( IQR: 58-73%). All the above post-intervention scores of PHMs in the IG were significantly higher in comparison to CG (p<0.001). Conclusions: This planned educational intervention had a significant impact on improving KAP of PHMs for early detection of breast cancer in the Gampaha district.

• Journal of East-West Nursing Research
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• v.13 no.2
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• pp.160-169
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• 2007

Background: Hwa-Byung is known as a specific Korean cultural syndrome which corresponds to DSM-IV(MMPI). Some Korean women who have experienced heart aching anger(Hwa-Byung) complain physical pains as well as psychological problems. As for these physical pains, upper limb arthropathy(e.g. golf elbow pains, tennis elbow pains, or shoulder-joint pains) have not been paid attentions. In spite of not having done her excessive physical endeavor or exercise, some Korean middle aged women complain those arthropathy pains. And they go round orthopedics, pain clinics, and oriental medicine clinics. Purpose: This study was practiced in Severance Oriental Medicine Clinic. The oriental medicine doctor had a question about the major origin of upper limb pains which were not caused by excessive physical endeavor. To answer the question, this study has been practiced. In the process of interview with some those women, the major cause of those syndromes has been revealed as Hwa-Byung. The purpose of this study is to discover the meanings of the women's life who have been experienced Hwa-Byung with upper limb arthropathy. Results: These upper limb arthropathy can be explained by meridian theory. Shoulder-joint pain and golf elbow with Hwabyung can be explained by Heart meridian of hand-shoyin and the points of these pains are in the flow of this meridian. Tennis elbow with Hwabyung can be explained by Small intestine meridian of hand-taiyang and this point is in the flow of this meridian. The results of interview with 9 middle aged women was analyzed and interpreted according to Spradley's method of ethnography. The analysis revealed three core cultural themes : 1) There are certainly external cause to provoke Hwa-Byung. A patricentric family system, husband's playing around with another woman, cruel treatment by husband's family, or financial failure may be present anteriorly. 2) The chief existing condition is the discord between husband and wife. The stoppage of mutual communication, lacking in understanding, unfeeling, heartless, or unsympathetic is an major phenomenon of married life. So the important factor is not the sexual relations or problems but the discords of communication. 3) The feeling of anger, the sense of nihility, the desire to escape, and the effort to forgiveness coexist together. At a glance, they seemed to be a process. For example, anger seemed to present at first, then nihility seemed at second, then escape seemed at third, and then forgiveness seemed at last. But at point of visiting clinic to be treated, they are mixed up together as if in a jumble.

• Journal of Preventive Medicine and Public Health
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• v.21 no.1 s.23
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• pp.10-20
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• 1988

This study was conducted to compare the maternal charactristics, and birth weight of infants delivered at five different categories of medical facility in Taegu to examine the risk level of pregnant women and children by the medical facility for delivery. The study population included 1,410 pregnant women who delivered a baby at one of nine medical facilities (3 university hospitals, 2 general hospitals, 2 private clinics, 1 midwife clinic, 1 MCH center) in Taegu in April, 1987(April and May, 1987 for K university hospital), Pregnant women were interviewed to ask the age and educational level of woman, payment of medical fee, birth order, delivery method. Birth weight of infant was obtained from medical record. Mean ages of the women delivering at the university hospitals(27.5 years) and at general hospitals(26.7 years) were higher than those at midwife clinic(25.4 years) and at MCH center(26.1 years). Also, mean years of school education were higher in women of university hospitals(12.7 years) and general hospitals (12.2 years) than in women of midwife clinic(9.2 years) and MCH center (9.3 years). The percentages of women covered by the medical insurance were far greater in the university hospitals(78.1%) and general hospitals(82.9%) than in private clinics(44.3%) , midwife clinic(29.1%) and MCH center (5.4%). Infants born at the MCH center were mostly the second birth (47.3%) while 56.0% to 61.7% of infants born at all the other medical facilities were the first birth more women delivering at the university hospitals had history of spontaneous abortion as well as still birth than the women delivering at the other medical facilities. The preform birth rate (11.4%) and low birthweight incidence rates(5.8-13.0%) in university hospitals were significantly higher than those of other medical facilities. Accordingly, c-section rates showed a wide variation among the medical facilities. Study findings revealed that most of women delivering at the university hospitals and general hospitals are in the middle of or upper socio-economic class and obstetrically high risk group regardless of socioeconomic class while the wome delivering at the midwife clinic and MCH center are low risk group of low socioeconomic class. Therefore, the data of a specific medical facility are highly limited in interpretation and can not be generalized.